AIMS: The objective of this study was to evaluate the long-term efficacy of percutaneous tibial nerve stimulation (PTNS) for treatment of patients with overactive bladder (OAB) and trying to find a maintenance protocol for its use.
PATIENTS AND METHODS: A total of 80 patients with overactive bladder were studied. All patients received a weekly stimulation of 30 minutes for a 12 week period. 20 patients showed no improvement and they were excluded from the study. The remaining successfully treated 60 patients were evaluated both subjectively (urgency, frequency, leakage episodes and QoL) and objectively (cystometry) before starting the maintenance sessions. Patients were randomly divided into two groups, (Group 1) 30 patients subjected to stimulation every 2 weeks and (Group II) 30 patients subjected to stimulation every 4 weeks. Patients of both groups were reevaluated at 6 and 12 months for the same subjective and objective criteria.
RESULTS: Mid term evaluation at 6 months showed deterioration in 3 out of 30 patients of Group I and they were shifted to weekly stimulation for the next 6 months. Also, 12 out of 30 patients of Group II showed deterioration and they were shifted to stimulation every 2 weeks. At 12 months follow-up, 39 our of 60 patients (65%) were maintained with every 2 weeks stimulation and 18 out of 60 patients (30%) were maintained with every 4 weeks stimulation. While only 5% of patients required weekly stimulation.
CONCLUSIONS: Percutaneous tibial nerve stimulation is an effective, minimally invasive and safe option for treatment of patients with overactive bladder. However, the initial 12 sessions are not enough and maintenance therapy is almost always required. Although the best maintenance protocol is every 2 weeks stimulation it would be advisable to start with every month to avoid unnecessary maneuver.